Provider Demographics
NPI:1588730386
Name:BECKLEY ORTHOTICS AND PROSTHETICS LLC
Entity type:Organization
Organization Name:BECKLEY ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO BOCP
Authorized Official - Phone:304-254-8285
Mailing Address - Street 1:471 NORTH VANCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-0471
Mailing Address - Country:US
Mailing Address - Phone:304-254-8285
Mailing Address - Fax:304-254-8286
Practice Address - Street 1:471 NORTH VANCE DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-0471
Practice Address - Country:US
Practice Address - Phone:304-254-8285
Practice Address - Fax:304-254-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1047281OtherBRICKSTREET MUTUAL WORKER
WV001388710OtherBLUE CROSS BLUE SHIELD
WV9100003000Medicaid